Key Takeaways
Almost 40% of emergency medical services calls in rural areas were for patients facing medically complex injuries compared with 26.4% nationally.
Rural patients were four times more likely to end up at trauma centers designated for less severe injuries and five times more likely to go to critical access hospitals – small, rural hospitals that provide essential care.
Call times for rural patients transported to specialty centers were more than 40 minutes longer compared with the national average.
CHICAGO (October 3, 2025) — Response times for emergency medical services (EMS) in rural areas can take almost 20 minutes longer compared to the national average, and the severity of the medical needs in these communities are likely to be much worse, according to an analysis of a large national EMS database.
Results of the study are being presented at the American College of Surgeons (ACS) Clinical Congress 2025 in Chicago, October 4-7.
"EMS response times in rural areas are considerably longer than what you would see in an urban or suburban setting," said Isabella Turcinovic, lead study author and a third-year medical student at Baylor College of Medicine in Houston, Texas. "In an emergency, this can be the difference between life or death for many patients."
Turcinovic and her co-authors analyzed EMS and patient data from the National Emergency Medical Services Information System, comparing outcomes between rural (more than 4.8 million) and national EMS (64.6 million) calls from January 2023 to January 2025. Key outcomes were total call times, which included scene response, on-scene, and transport times, along with severity of patient injury (evaluated as high or low patient acuity) and the type of hospital the patients were taken to.
Key Findings
EMS call times across all severity (acuity) levels were 92.8 minutes in rural communities compared with 74.1 minutes nationally.
High-acuity activations, meaning EMS calls treating patients with very severe medical issues or injury, were far more common in rural settings: 39.3% compared with 26.4% nationally.
Among patients with more severe (high acuity) injuries, total call times were almost 30 minutes longer: 97.1 minutes compared with 69 minutes nationally. For these patients transported to specialty centers, the call times were even longer: 155 minutes compared with 114 minutes.
Rural patients were four times more likely to be transported to a trauma center designated for less severe injuries (8% compared with 2%) and five times more likely to go to a critical access hospital (10% compared with 2%). Level 1 and 2 trauma centers are designated to treat patients with more complex injuries.
"These data demonstrate a disparity in access to care," said senior author Chad T. Wilson, MD, MPH, FACS, associate professor of surgery at Baylor and section chief of acute care surgery at Ben Taub Hospital in Houston.
The study findings underscore the role of rural hospitals as a first point of treatment for many patients in rural areas, Turcinovic said. "Rural patients present to critical access hospitals at far higher proportions than urban counterparts, highlighting the importance of these rural hospitals, especially at a time when their funding can be constrained," she said. "The findings also illustrate why rural hospitals may need support for the management of high-acuity patients."
A number of factors may explain why a higher percentage of rural EMS patients present with more severe injuries, Turcinovic added. "I think of it as an acute and chronic concern," she said. "It's been established in the literature, unfortunately, multiple times, that rural patients are more likely to have limited access to care, which prevents early or adequate management of medical problems, resulting in more acute exacerbations. Secondly, rural communities have higher rates of injury from work from longer commuting distances and higher commuting speeds."
Turcinovic said the group plans further research in this area. Policymakers and planners may use this information to further justify the need for rural hospitals and to better deploy EMS resources in rural areas, she said.
Lubna Khan, MD, a surgical resident at Baylor, is a co-author of the study.
Disclosures: The study authors reported no relevant disclosures.
Citation: Khan L, et al. Disparities in Timely Access to Prehospital Care in Rural America. Scientific Forum, American College of Surgeons Clinical Congress 2025.
Note: This research was presented as an abstract at the ACS Clinical Congress Scientific Forum. Research abstracts presented at the ACS Clinical Congress Scientific Forum are reviewed and selected by a program committee but are not yet peer reviewed.
